ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121907.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121908.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121909.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo examine the perinatal characteristics of all higher order multiple births (133 sets of triplets and six sets of quadruplets) in the State of Victoria between 1982 and 1990. To compare the rising higher order multiple birth rates in Victoria with those in the other States of Australia, and to assess the impact of in‐vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) on these rising birth rates.DesignRetrospective review of all higher order multiple births registered in Victoria and other States of Australia between 1982 and 1990, and in particular those resulting from IVF and GIFT.Data sourcesVictorian Perinatal Data Collection Unit, Australian Bureau of Statistics, National Perinatal Statistics Unit, data from Victorian IVF and GIFT units.Main outcome measuresHigher order multiple birth rates and perinatal mortality rates.ResultsThe higher order multiple birth rates in Victoria rose from 3.5 per 10 000 in 1982 to 10.9 per 10 000 in 1990. The average perinatal mortality rates for the Victorian triplets and quadruplets born during this period were 10.8% and 25.0%, respectively. The rates of caesarean section were 70% and 83%; the proportions of deliveries in level III hospitals, 75% and 100%; and the mean maternal lengths of stay in hospital, 32 and 57 days, respectively. Endotracheal intubation was performed at birth in 18.5% of all infants. The proportions of triplet and quadruplet pregnancies in Victoria owing to IVF and GIFT rose during this period, reaching a peak of 42% in 1990. In the other States, the birth rates for higher order multiples increased at 1.8 times the rate observed for Victoria, with IVF and GIFT contributing to an estimated 43% of these conceptions between 1985 and 1989.ConclusionRestrictions on the numbers of embryos/oocytes transferred during IVF and GIFT should reduce the frequency of higher order multiple births.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121910.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985–1990 period.DesignAnalysis of birthweight‐specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors.Subjects114 725 singleton births of at least 400 g birthweight (or at least 20 weeks’ gestation) born in hospitals in the 1985–1990 period and notified to the perinatal data collection.Main outcome measureThe relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period.ResultsBirths at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birthweights, there was a higher risk at non‐level‐3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500–2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight.ConclusionsThe greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500–2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121911.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo discuss the place of, and indications for, percutaneous cervical cordotomy in the relief of cancer pain and to report a series of patients on whom the operation was performed at the Royal Brisbane Hospital.Setting and patientsTwo hundred and seventy‐three patients underwent percutaneous cervical cordotomy of approximately 4000 cancer patients referred to the Pain Clinic, Royal Brisbane Hospital, a tertiary referral centre, in the years 1979 to 1991. Both public and private patients were included. All received the same level of clinical care from the authors, all operations being performed by the first author. The major indication for the procedure was unilateral cancer pain below the head and neck, but other factors influencing the decision for operation were respiratory function, age, general condition and expectation of life.Major outcome measuresEffectiveness of pain relief, first‐week mortality, quality of life.ResultsSatisfactory pain relief was achieved in 89% of patients. First‐week mortality was 3.3%. Long‐term survivors (eight and five years) have remained free of their original pain. Particular emphasis is placed on the successful pain relief in 114 patients suffering from primary lung cancer, including mesothelioma. Side effects and complications have been few.ConclusionUnilateral percutaneous cervical cordotomy is a valuable method of treatment of cancer pain in selected patients. The procedure has a special place in the treatment of the large group of patients suffering pain associated with primary lung cancer including mesothelioma. We support the view of overseas workers that percutaneous cervical cordotomy is the only effective method of achieving stable pain control in these patients, many of whom are referred late.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121912.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo obtain a comprehensive overview of bacteraemia and fungaemia in a general hospital and thus to determine the incidence, primary sites of sepsis, organisms involved and associated mortality.DesignA prospective laboratory and clinical evaluation of all episodes where microorganisms were cultured from blood over one year.SettingThe two major hospitals in the Australian Capital Territory which have both community and referral functions. These hospitals provide obstetric and paediatric services along with adult medicine and surgery.PatientsAll those who acquired bacteraemia in hospital or presented with a bloodstream infection documented by a positive blood culture.ResultsDuring 1990, 474 clinical episodes of bacteraemia or fungaemia were detected in 446 patients. Significant isolates were identified in 317 of these episodes. The incidence of significant sepsis was 8.1 episodes per 1000 admissions. The most common organisms isolated wereStaphylococcus aureus(75 episodes) andEscherichia coli(70 episodes). One hundred and twenty‐eight episodes were hospital acquired. Intravenous catheters were the primary sites of sepsis in 68 episodes. Fifty patients died. Higher mortality rates were associated with patients over 60 years of age, respiratory tract sepsis, endocarditis and the presence of an underlying malignancy.ConclusionBacteraemia and fungaemia are common problems. Nosocomial bacteraemia accounted for 40% of episodes. Half of these nosocomial infections were iatrogenic. Many of the episodes of intravenous catheter sepsis were potentially preventable. Ongoing programs of surveillance of bacteraemia, with the evaluation of primary site, associated features and mortality, are essential to monitor the dimensions of this problem and aid in implementing effective preventive strategies.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121913.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo investigate whether the syndrome of low systemic vascular resistance (SVR) following cardiac surgery and cardiopulmonary bypass (CPB) is more common in patients taking angiotensin‐converting enzyme inhibitors (ACE‐inhibitors) or calcium antagonists.DesignA case‐control study, with cases (“low SVR syndrome”) identified from intensive care unit observation charts. These cases were each matched to two controls identified from the same group of charts during the same time period. Exposure (ACE‐inhibitors or calcium antagonists) was determined in a blinded fashion from the patient's medical record.SettingCardiothoracic surgical unit in a teaching hospital.ParticipantsWe identified 42 cases of low SVR syndrome; these were matched to 84 controls.ResultsThere was no association between therapy with ACE‐inhibitors and the low SVR syndrome following CPB (odds ratio [OR], 1.33; 95% confidence interval [Cl], 0.53–3.34), nor with calcium antagonists (OR, 0.49; 95% Cl, 0.21–1.13). The incidence of the low SVR syndrome was 7.4%. Patients who develop the low SVR syndrome are more likely to be treated with noradrenaline, adrenaline and dopamine, and spend more time in the cardiothoracic intensive care unit.ConclusionThe “low SVR syndrome” following CPB is not associated with preoperative therapy with ACE‐inhibitors or calcium antagonists.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121914.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121915.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Control of the vector is usually a crucial factor in control programs for tropical diseases spread by insect vectors. Successful control programs aim at vulnerable points in the interactions between the vector, the reservoir host, the pathogen, the human host, and the environment. The objective is to prevent potential transmission, or interrupt actual transmission, by reducing the abundance, longevity, or host contact of the vector — whichever is most appropriate to the particular pathogen or disease and the local situation. The importance of individual assessment in the light of local conditions and a knowledge of the biology of the local vector is stressed. The vector‐borne diseases discussed here are malaria, filariasis, arbovirus diseases, trypanosomiasis, leishmaniasis, plague and rickettsiosis.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121916.x

出版商:Wiley    

年代:1993

数据来源: WILEY